Provider Demographics
NPI:1992735716
Name:CENICEROS, AMBER J (PA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:J
Last Name:CENICEROS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:J
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1025 STRAKA TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2544
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:405-604-0708
Practice Address - Street 1:1025 STRAKA TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2544
Practice Address - Country:US
Practice Address - Phone:405-632-6688
Practice Address - Fax:405-604-0708
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1501363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200076670AMedicaid
OK243608102Medicaid
OKQ66198Medicare UPIN